Onset of modified measles after etanercept treatment in rheumatoid arthritis

: Treatment with corticosteroid and etanercept was started for a 69-year-old woman with rheumatoid arthritis. Eight weeks later, she developed fever and anorexia, and was admitted to our hospital with a poor general condition. With the suspicion of bacterial infection, antibiotic treatment was started on the first hospital day, but was ineffective. From the fourth hospital day, multiple generalized, partially confluent, erythematous papules appeared. To exclude viral infection, we measured antibody titers against various viruses, and found that the levels of anti-measles IgG and IgM antibodies were elevated, which led to a diagnosis of modified measles. During the course of measles, she developed severe leukopenia, and bone marrow aspiration revealed bone marrow suppression. This was considered to be due to measles infection, leading to a diagnosis of severe modified measles. This is the first case report of modified measles which developed during the use of an anti-TNF-alpha preparation, and suggests that immunosuppression induced by the preparation may play a role in measles reinfection and its aggravation.